Healthcare Provider Details

I. General information

NPI: 1003887944
Provider Name (Legal Business Name): ALETA BELINDA GONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 N 35TH AVE
PHOENIX AZ
85053-3822
US

IV. Provider business mailing address

POST OFFICE BOX 11585
GLENDALE AZ
85318
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-3255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberAZ 835
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: